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Background Treatment-resistant depression (TRD) is a major challenge in clinical psychiatry, characterized by insufficient response to at least two different classes of antidepressants. Despite advances in treatment, many TRD patients continue to experience significant symptoms and reduced quality of life. The study aims to provide an exploratory assessment of toludesvenlafaxine hydrochloride sustained-release tablets for efficacy and safety in TRD. Methods We conducted an open-label, single-arm, exploratory 8-week study in adults with TRD ( n  = 31) receiving Toludesvenlafaxine. The primary endpoint was the change in the Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline to week 8. Secondary endpoints included changes in anxiety, quality of life, and functional status, as well as the assessment of safety. Results Within-group improvements were observed in MADRS scores at weeks 2, 4, and 8 compared with baseline ( P  < 0.0001), with an average reduction of -13.0 ± 9.6 at week 8. The MADRS response rate (≥ 50% reduction) was 22.6% at week 4 and 45.2% at week 8, while the remission rate (MADRS ≤ 12) was 9.7% at week 4 and 29.0% at week 8. Secondary outcomes, including the Hamilton Anxiety Rating Scale (HAMA), the Sheehan Disability Scale (SDS), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF), showed significant improvements from baseline. Toludesvenlafaxine was well-tolerated, with a low incidence of adverse events, none of which were severe. Conclusion These findings suggest that Toludesvenlafaxine may be associated with improvements in both depressive and anxiety symptoms, as well as quality of life, in patients with TRD. This study provides evidence supporting the use of Toludesvenlafaxine as an effective treatment option for TRD and emphasizes the need for further research to confirm its long-term efficacy and safety. Trial registration The study strictly adhered to the TREND guidelines, Chinese clinical trial Registry, ChiCTR2400080665, 2024-02-04. Clinical trial number RXL-SAT-06.

Toludesvenlafaxine hydrochloride sustained‐release tablets, as China’s first independently developed chemical Class 1 innovative drug with independent intellectual property rights for the treatment of depression and a new molecular entity, represent a novel triple reuptake inhibitor (TRI) with specific target selectivity for serotonin (5‐HT), norepinephrine (NE), and dopamine (DA). This single‐arm, multicenter clinical study aimed to evaluate the efficacy and safety of toludesvenlafaxine in alleviating anhedonia symptoms in patients with major depressive disorder (MDD). A total of 123 patients aged 18–65 years were enrolled between April 2023 and April 2024 and received an 8‐week treatment with toludesvenlafaxine sustained‐release tablets (80–160 mg/day). The primary efficacy endpoint was the change in the total score of the Dimensional Anhedonia Rating Scale (DARS) at weeks 2, 4, and 8. Significant improvements in DARS scores were observed, with mean changes from baseline of 8.4 (95% CI [6.4, 10.4], p < 0.0001), 14.1 (95% CI [12.0, 16.2], p < 0.0001), and 20.4 (95% CI [18.0, 22.9], p < 0.0001), respectively. Additionally, after 8 weeks of treatment, plasma levels of neurotrophic factors, including mature brain‐derived neurotrophic factor (mBDNF) ( t = 28.78, p < 0.0001), pro‐BDNF ( t = 27.71, p < 0.0001), and vascular endothelial growth factor (VEGF) ( t = 31.07, p < 0.0001), were significantly increased, and the plasma level of IGF‐1 was not significantly changed ( t = 0.35, p = 0.7269). No association was found between the percentage of changes in neurotrophic factors and the percentage of symptom improvements. Toludesvenlafaxine was generally well‐tolerated, with treatment‐emergent adverse events (AEs) (TEAEs) reported in 83.7% of participants and treatment‐related AEs (TRAEs) in 76.4%. These findings indicate that toludesvenlafaxine hydrochloride sustained‐release tablets are safe, well‐tolerated, and effective in alleviating anhedonia symptoms in patients with depression. Trial Registration: http://www.chictr.org.cn (No.: ChiCTR2300070331).

Objectives: To evaluate the short-term efficacy and safety of desvenlafaxine (25–50 mg/d) compared with placebo in children and adolescents with major depressive disorder (MDD). Methods: Outpatient children (7–11 years) and adolescents (12–17 years) who met DSM-IV-TR criteria for MDD and had screening and baseline Children's Depression Rating Scale–Revised (CDRS-R) total scores >40 were randomly assigned to 8-week treatment with placebo, desvenlafaxine (25, 35, or 50 mg/d based on baseline weight), or fluoxetine (20 mg/d). The primary efficacy endpoint was change from baseline in CDRS-R total score at week 8, analyzed using a mixed-effects model for repeated measures. Secondary efficacy endpoints included week 8 Clinical Global Impressions–Severity, Clinical Global Impressions–Improvement (CGI-I), and response (CGI-I ≤ 2). Safety assessments included adverse events, physical and vital sign measurements, laboratory evaluations, electrocardiogram, and the Columbia-Suicide Severity Rating Scale. Results: The safety population included 339 patients (children, n = 130; adolescents, n = 209). The primary endpoint, change from baseline in CDRS-R total score at week 8, did not statistically separate from placebo, for either desvenlafaxine (adjusted mean [standard error] change, −22.6 [1.17]) or fluoxetine (−24.8 [1.17]; placebo, −23.1 [1.18]). Week 8 CGI-I response rates were significantly greater for fluoxetine (78.2%; p = 0.017) than for placebo (62.6%); desvenlafaxine (68.7%) did not differ from placebo. Other secondary outcomes were consistent with those obtained with CDRS-R. Rates of treatment-emergent adverse events were comparable among treatment groups (desvenlafaxine, 60.0%; placebo, 70.5%; and fluoxetine, 64.3%). Conclusion: Desvenlafaxine did not demonstrate efficacy for treating MDD in children and adolescents in this trial. Because neither desvenlafaxine nor the reference medication, fluoxetine, demonstrated a statistically significant difference from placebo on the primary endpoint, this was considered a failed trial and no efficacy conclusions can be drawn. Desvenlafaxine 25–50 mg/d was generally safe and well tolerated in children and adolescents in this study.

Pregnancy-induced physiological changes can substantially alter venlafaxine pharmacokinetics. Despite the clinical relevance of both venlafaxine and its active metabolite, O-desmethylvenlafaxine (ODV), no physiologically-based pharmacokinetic (PBPK) models have been developed that simultaneously describe their disposition during pregnancy. In this study a PBPK model was developed to predict maternal and fetal exposure to venlafaxine and ODV and to optimize dosing regimens. PBPK models for venlafaxine and ODV in non-pregnant women, pregnant women, and the fetal-placental unit were developed using the Simcyp simulator. Model performance was evaluated using visual predictive checks, assessing whether observed data were contained within the predicted 95% confidence intervals, and by comparing predicted versus observed ratios for maximum plasma concentration (C ) and area under the concentration-time curve (AUC) using a prespecified range (0.7-1.3). In non-pregnant women, observed venlafaxine and ODV concentrations fell within the 95% confidence intervals of model predictions, with C and AUC prediction ratios between 0.7 and 1.3. Most observed data in pregnant women also fell within the 95% confidence intervals. Venlafaxine and ODV concentrations decreased as pregnancy progressed for doses ranging from 37.5 to 225 mg. Cord-to-maternal concentration ratios were approximately 1.02 at 37.5-150 mg and 1.01 at 225 mg. Predicted venlafaxine and ODV concentrations remained within the therapeutic range (100-400 ng/mL) at 150 mg during the first and second trimesters, whereas 225 mg was necessary in the third trimester. At a 375 mg dose, the umbilical cord C for venlafaxine reached 195.26 ng/mL, a level approaching thresholds of fetal toxicity. These findings should be interpreted with caution, given the limited sample size in pregnant women (n= 7 for plasma and n=9 for cord blood). A venlafaxine dose of 150 mg/day is recommended during pregnancy, balancing efficacy with the risk of toxicity in both mother and fetus.

Objective: To evaluate the short-term efficacy and safety of desvenlafaxine versus placebo in the treatment of children and adolescents with major depressive disorder (MDD). Methods: Outpatient children (7–11 years) and adolescents (12–17 years) who met DSM-IV-TR criteria for MDD and had screening and baseline Children's Depression Rating Scale-Revised (CDRS-R) total scores >40 were randomly assigned to 8 weeks of treatment with placebo, low exposure desvenlafaxine (20, 30, or 35 mg/day based on baseline weight), or higher exposure desvenlafaxine (25, 35, or 50 mg/day based on baseline weight). The primary efficacy endpoint was change from baseline in CDRS-R total score at week 8, analyzed using a mixed-effects model for repeated measures. Secondary efficacy assessments included Clinical Global Impressions-Severity and Clinical Global Impressions-Improvement scales. Safety assessments included adverse events and the Columbia-Suicide Severity Rating Scale. Results: The safety population included 363 patients (children, n = 109; adolescents, n = 254). No statistical separation from placebo was observed for either desvenlafaxine group for CDRS-R total score or for any secondary efficacy endpoint. At week 8, adjusted mean (standard error) changes from baseline in CDRS-R total score for the desvenlafaxine low exposure, desvenlafaxine high exposure, and placebo groups were −23.7 (1.1), −24.4 (1.1), and −22.9 (1.1), respectively. The incidence of adverse events was similar among groups. Conclusion: Low and high exposure desvenlafaxine groups did not demonstrate efficacy for the treatment of MDD in children and adolescents in this double-blind, placebo-controlled trial. Desvenlafaxine (20–50 mg/day) was generally safe and well tolerated with no new safety signals identified in pediatric patients with MDD in this study.

The objective of this study was to develop a dissolution test in order to establish an in vitro–in vivo correlation (IVIVC) model for desvenlafaxine succinate monohydrate (DVSM) extended release (ER) tablets. The in vitro release characteristics of the drug were determined using USP apparatus 1 at 75 rpm, with volume of HCl pH 1.2, acetate buffer solution (ABS) pH 4.5, or phosphate buffer solution (PBS) pH 6.8. In vivo plasma concentrations and pharmacokinetic parameters in healthy volunteers were obtained from a bioequivalence study. The similarity factors f1 and f2 were used to compare the dissolution data. The IVIVC model was developed using fraction dissolved and fraction absorbed of the reference product. For predictability, the results showed that the percentage prediction error (%PE) value of Cmax was 7.63%. The observed low prediction error for Cmax demonstrated that the IVIVC model was valid for this parameter.

Two similarly designed extension studies evaluated the long-term safety and tolerability of desvenlafaxine for the treatment of children and adolescents with major depressive disorder (MDD). Efficacy was evaluated as a secondary objective. Both 6-month, open-label, flexible-dose extension studies enrolled children and adolescents who had completed one of two double-blind, placebo-controlled, lead-in studies. One lead-in study included a 1-week transition period prior to the extension study. Patients received 26-week treatment with flexible-dose desvenlafaxine (20-50 mg/d). Safety assessments included comprehensive psychiatric evaluations, vital sign assessments, laboratory evaluations, 12-lead electrocardiogram, physical examination with Tanner assessment, and Columbia-Suicide Severity Rating Scale. Adverse events (AEs) were collected throughout the studies. Efficacy was assessed using the Children's Depression Rating Scale-Revised (CDRS-R). A total of 552 patients enrolled (completion rates: 66.4 and 69.1%). AEs were reported by 79.4 and 79.1% of patients in the two studies; 8.9 and 5.2% discontinued due to AEs. Treatment-emergent suicidal ideation or behavior was reported for 16.6 and 14.1% of patients in the two studies. Mean (SD) CDRS-R total score decreased from 33.83 (11.93) and 30.92 (10.20) at the extension study baseline to 24.31 (7.48) and 24.92 (8.45), respectively, at week 26. Desvenlafaxine 20 to 50 mg/d was generally safe and well tolerated with no new safety signals identified in children and adolescents with MDD who received up to 6 months of treatment in these studies. Patients maintained the reduction in severity of depressive symptoms observed in all treatment groups at the end of the lead-in study.

The value of early functional improvement at week 2 for predicting subsequent functional outcomes at week 8 was assessed in a pooled analysis of patients with major depressive disorder (MDD) treated with desvenlafaxine (50 or 100 mg/d) or placebo. Data were pooled from eight double-blind, placebo-controlled studies of desvenlafaxine 50 mg/d or 100 mg/d for the treatment of MDD. Optimal week-2 improvement thresholds in Sheehan Disability Scale (SDS) score, which best predicted week-8 treatment success, were determined using receiver operating characteristic (ROC) analysis. Four definitions of treatment success were established: (1) functional response, (2) functional/depression response, (3) functional remission, and (4) functional/depression remission. Odds ratios (ORs) of early improvement for prediction (based on thresholds determined in the ROC analysis) of week-8 treatment success were computed using logistic regression models. Functional early improvement thresholds of 17%-32% were predictive of week-8 treatment success across treatment groups and definitions of treatment success. Optimal thresholds were higher for more stringent definitions. Negative predictive value exceeded positive predictive value, indicating that failure to achieve early functional improvement was more informative about later treatment success than was the achievement of early functional improvement. Early change in SDS was a highly significant predictor of functional response/remission (ORs, 4.981-8.737; all p < 0.0001); the interaction between treatment and early functional improvement was not significant. Early improvement in SDS total score was predictive of functional outcomes for patients treated with desvenlafaxine 50 mg, desvenlafaxine 100 mg, or placebo.

This post-hoc pooled analysis evaluated categorical change in functional impairment in patients with major depressive disorder (MDD) treated with desvenlafaxine versus placebo and examined whether early improvement in functioning predicted functional outcomes at study endpoint. Data were pooled from eight randomized, double-blind, placebo-controlled studies of desvenlafaxine for the treatment of MDD, including adults who were randomly assigned to receive desvenlafaxine 50 or 100 mg/d or placebo (N=3,384). Shift tables were generated for categorical changes in functional impairment from baseline based on Sheehan Disability Scale (SDS) subscale scores. The categories were none/mild (0-3), moderate (4-6), and marked/extreme (7-10). Treatment comparisons for prespecified shifts of interest and predictive value of week 2 or 4 improvement in SDS subscale scores for functional outcome at week 8 were assessed using logistic regression. Greater proportions of patients receiving desvenlafaxine 50 and 100 mg achieved improvement from baseline to week 8 for each prespecified shift endpoint versus placebo (all p ≤ 0.02). Early improvement in SDS subscale scores was a statistically significant predictor of functional outcome at week 8, both overall and for each treatment group (all p<0.0001). Treatment with desvenlafaxine 50 or 100 mg/d led to significantly greater categorical improvement in functional impairment versus placebo, and improvement in SDS subscale scores significantly predicted functional outcome. Monitoring patient progress early in the course of antidepressant treatment using a functional assessment such as the SDS may help clinicians determine whether or not treatment adjustments are needed.